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| |  ISC: Prophylactic Aspirin May Reduce Severity of Strokes Compared With Other Anti-Thrombotics By Cameron Johnston NEW ORLEANS, LA -- February 7, 2005 -- Aspirin, used prophylactically, may help reduce severity of strokes more effectively than other anti-thrombotic therapies, say investigators from the University of California in Los Angeles, California, United States. Much has been made over the prophylactic use of aspirin to minimize the risk of stroke in some patients. Some studies have also suggested that patients who use aspirin at the time of their initial stroke also have better outcomes. In this study, the investigators attempted to draw some conclusions between pre-event use of aspirin and the severity of the event when it occurs. Presenting their results at the 30th International Stroke Conference, they explained that, according to their findings, patients who are taking aspirin prophylactically when they have a stroke, will have a less severe event than those who are taking other anti-thrombotic agents. Two hundred sixty consecutive patients with first-ever strokes were categorized as to whether they were using an aspirin-based regimen which could include aspirin alone, or with dipyridamole or clopidogrel (n=86); another anti-thrombotic agent other than aspirin (clopidogrel alone, ticlopidine, warfarin n=32)) or no anti-thrombotic agent at all (n=138). The severity of their stroke was recorded upon admission using the NIHSS, and outcome was measured at discharge with the modified Rankin Scale (mRS). Patients who were using an aspirin-based therapy at the time of their event had lower NIHSS than those who were using non-aspirin based anti-thrombotic therapy (NIHSS = 4 vs. 8) and lower than those who were using no anti-thrombotic therapy at all (NIHSS = 4 vs. 7). The associations were all just as strong when patient characteristics were adjusted for age, sex, presence or absence of diabetes, atrial fibrillation or history of previous stroke. There was no difference in scores between patients who were using non-aspirin based anti-thrombotics and those who were not using any kind of agent at all (NIHSS 7 vs. 8). More patients using aspirin-based prophylaxis had mild strokes compared with those who were taking either non-aspirin based anti-thrombotics or no anti-thrombotics at all (61% vs. 45% vs. 49%). There were also fewer severe strokes (NIHSS = 16-42) among those using aspirin (13%) compared with those using non-aspirin anti-thrombotics (24%) and those using no prophylaxis at all (23%). Modified Rankin Scores at discharge also reflected a trend toward better outcomes among patients using aspirin compared with the other agents. Median mRS scores were 1.67, 2.53 and 2.12 for those using aspirin, non-aspirin-based prophylaxis, or no prophylaxis. The percentage of patients at discharge with modified Rankins of 0-2, indicating a good outcome, were 62%, 37% and 48% for the three groups respectively. The authors of the study, headed by Nerses Sanossian, MD, a stroke neurologist with the UCLA Stroke Center, suggest that aspirin may be more protective than the other agents because it limits the size of the thrombus and restricts clot propagation. It may improve microcirculation and reduce platelet microaggregates, and aspirin itself may have neuroprotective and antioxidant effects. They note that it is "very interesting" that the effect seems limited to aspirin alone and not to all anti-thrombotic agents.
[Presentation title: Aspirin-Based Antithrombotic Regimen Is Associated With Less Severe Stroke. Abstract P88]
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